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In 962 people interviewed six times over 18 months after surgery for a first non-metastatic cancer, 59 per cent had insomnia symptoms at the start, 28 per cent met criteria for an insomnia syndrome, and 36 per cent still had symptoms at 18 months. A short course of talking therapy for insomnia improved sleep efficiency by 15.5 per cent against 6.1 per cent in controls.
This is the most tractable problem in this part of the front, and the one most likely to go unmentioned in a clinic.
How common, and for how long. Everyone scheduled for curative surgery for a first non-metastatic cancer at one centre was approached, and 962 people completed a diagnostic interview for insomnia at the time of surgery and again at 2, 6, 10, 14 and 18 months. At baseline 59 per cent had insomnia symptoms, including 28 per cent who met criteria for an insomnia syndrome. The prevalence fell over time but was still 36 per cent at 18 months. Rates were highest in breast cancer, running from 42 to 69 per cent across the time points, and in gynaecological cancer, 33 to 68 per cent, and lowest in men with prostate cancer, 25 to 39 per cent. Nearly 15 per cent of people developed insomnia for the first time during the study and 19.5 per cent relapsed after remitting.
The part that decides what to do. Remission was much less likely for those who had a full insomnia syndrome, 10.8 to 14.9 per cent across the intervals, than for those with insomnia symptoms alone, 42.0 to 51.3 per cent. Most commonly, 37.6 per cent of those with a syndrome at baseline kept that status throughout the 18 months. In plain terms: broken sleep in the weeks around treatment usually settles by itself; established insomnia usually does not, and waiting for it to is the commonest mistake.
What causes it. Pain, nocturia, hot flushes from hormone treatment or from treatment-induced menopause, steroids given with chemotherapy, nausea, anxiety, hospital admission, daytime napping imposed by fatigue, and the loss of a regular daily structure when work stops. The body record in this front covers hot flushes and fatigue; the menopause record covers the night sweats. Several of those causes are treatable in their own right, and should be, but the insomnia often outlasts them, because what keeps insomnia going after the trigger has gone is the behaviour it produced: more time in bed, variable rising times, and the effort of trying to sleep.
The treatment. A meta-analysis of eight randomised trials and 752 people with a cancer diagnosis and clinically relevant insomnia found that cognitive behavioural therapy for insomnia improved sleep efficiency, the proportion of time in bed actually spent asleep, by 15.5 per cent against 6.1 per cent in the control conditions, a medium effect size of 0.53. Time to fall asleep fell by 22 minutes against 8 minutes in controls, effect size 0.43; time awake after falling asleep fell by 30 minutes against 13, effect size 0.41. The effect on self-reported insomnia severity was large, 0.77, representing a clinically relevant eight-point reduction, and effects were durable to six months. The reviewers' conclusion: "The quality of the evidence supports a strong recommendation for the use of CBT-I among cancer survivors." The corpus already carries the treatment record, including the digital versions that reach people who cannot get to a therapist.
That makes this the best-evidenced treatment of anything on this facet. A fear-of-recurrence programme shifts its outcome by about a third of a standard deviation; a return-to-work programme raises the proportion returning by about a quarter; this moves reported insomnia severity by three quarters of a standard deviation and holds for six months. It takes a handful of sessions, it has no drug interactions, and it is the thing to ask for.
What is not known. Whether treating insomnia changes anything about the cancer is unproven, and the corpus carries a proposal to test it; the sleep and circadian record is explicit that this is open. The longitudinal cohort above followed people having curative surgery, so it does not describe sleep in advanced disease, where the one placebo-controlled drug trial randomised 21 people and is covered on the record alongside this one.
Insomnia is precipitated by an event and perpetuated by the adaptations to it. Spending longer in bed to catch up weakens the association between bed and sleep and fragments it further; irregular rising times uncouple the circadian signal from the sleep drive; and effortful trying raises arousal at exactly the moment it needs to fall. Cognitive behavioural therapy for insomnia reverses each of those directly through sleep restriction, stimulus control and work on sleep-related beliefs, which is why it outlasts the course and why a sedative, which addresses none of them, does not.
Query for this technology: (TITLE:"Sleep after cancer: how common insomnia is, how long it lasts, and the treatment that works" OR ABSTRACT:"Sleep after cancer: how common insomnia is, how long it lasts, and the treatment that works") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Sleep after cancer: how common insomnia is, how long it lasts, and the treatment that works, not a curated reading list.
Shares Fatigue after cancer treatment: what actually works, Cancer-related fatigue (tiredness), The exercise prescription after cancer: the dose the guidelines state, Quality of life and the tags rejuvenation, survivorship, psychosocial.
Shares Mindfulness-based stress reduction and cognitive therapy, The exercise prescription after cancer: the dose the guidelines state, Quality of life, Late effects and survivorship toxicity and the tags rejuvenation, survivorship, psychosocial.
Shares Mindfulness-based stress reduction and cognitive therapy, Cognitive behavioural therapy for insomnia (CBT-I), Quality of life, Survivorship care and late-effects surveillance and the tags rejuvenation, survivorship, psychosocial.
Shares Mindfulness-based stress reduction and cognitive therapy, Quality of life, Late effects and survivorship toxicity, Survivorship and late effects are neglected and the tags rejuvenation, survivorship, psychosocial.
Shares Quality of life, Survivorship care and late-effects surveillance, Late effects and survivorship toxicity, Survivorship and late effects are neglected and the tags rejuvenation, survivorship, psychosocial.
Shares Mindfulness-based stress reduction and cognitive therapy, Quality of life, Survivorship and late effects are neglected, Hodgkin lymphoma and the tags rejuvenation, survivorship, psychosocial.
Shares Quality of life, Survivorship care and late-effects surveillance, Late effects and survivorship toxicity, Survivorship and late effects are neglected and the tags rejuvenation, survivorship, psychosocial.
Shares Quality of life, Late effects and survivorship toxicity, Survivorship and late effects are neglected, Toxicity and quality of life are undervalued and the tags rejuvenation, survivorship, psychosocial.